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Nephrologists often order genetic testing panels to clarify diagnoses in patients with diverse presentations of kidney disease. This was not the case 10 years ago, prior to the current era of precision medicine. In the past, elevated blood sugars and blood pressures were felt to be the primary factors that initiated diabetic and mislabeled "hypertensive" nephropathy. In addition, the markedly higher incidence rates of kidney failure in African Americans relative to European, Asian, and Hispanic Americans were poorly understood. This changed with recognition of marked familial aggregation of kidney failure, particularly in the African American population. The 2010 discovery of the apolipoprotein L1 gene (APOL1) association with chronic kidney disease demonstrated that two coding variants in a single gene caused more than 35% of kidney failure in African Americans. APOL1 explained ancestry-based disparities in incidence rates of nephropathy, as well as outcomes after kidney transplantation and live kidney donation. This manuscript reviews the APOL1 discovery and its resultant changes in our understanding of kidney disease susceptibility. Mechanisms of APOL1 injury in kidney cells and novel therapies are reviewed with an emphasis on gaps in existing knowledge and future directions.

Valvular heart disease (VHD) is associated with substantial morbidity, mortality, and health care costs, yet its contemporary prevalence among older adults in the United States is unknown. We performed a decentralized study of older adults (PREVUE-VALVE) to determine the population prevalence of VHD among older Americans. Individuals 65-85 years old who previously filled a prescription at CVS or Walgreens pharmacies were randomly selected; contacted via e-mail, direct mail, or text messaging; and invited to participate. Enrolled participants completed study procedures in their homes, including a comprehensive transthoracic echocardiogram. The primary endpoint was the prevalence of moderate or greater (≥ moderate) VHD, weighted to reflect the U.S. The co-primary endpoint was the prevalence of clinically significant VHD, which also included mild-to-moderate regurgitant disease. The study sample (n = 3,000) was representative of older Americans (median age 71 years, 57.1% female, 14.6% non-Hispanic Black, 9.4% Hispanic). The weighted prevalence of ≥ moderate VHD was 8.2% (95% CI: 7.0%-9.5%), which increased to 18.4% (95% CI: 16.7%-20.2%) for clinically significant VHD. Tricuspid regurgitation was the most common lesion, followed by aortic stenosis, mitral regurgitation, aortic regurgitation, and mitral stenosis. Older age, but not sex, was associated with greater prevalence. In age- and sex-adjusted analyses, non-Hispanic Black individuals had a lower prevalence of any VHD compared with non-Hispanic White individuals (adjusted RR: 0.91; 95% CI: 0.83-0.99), driven predominantly by lower rates of aortic stenosis and regurgitation. There were no significant adjusted differences in VHD prevalence between Hispanic and non-Hispanic individuals. Extrapolation of these data to the U.S. population indicates that at least 4.7 million 65-85-year-olds currently have ≥ moderate VHD, and 10.6 million currently have clinically significant VHD-values that are projected to increase to 6.5 and 14.7 million, respectively, by 2060. In this national in-home echocardiography study, VHD was common among older adults, with important age-related and valve-specific patterns. PREVUE-VALVE establishes the feasibility of large-scale decentralized cardiovascular imaging studies and provides a contemporary foundation for clinical and policy planning related to the burden of VHD. (Age- and Sex-Specific Prevalence of Acquired Valvular Heart Disease (PREVUE-VALVE; NCT05357404).

Immune checkpoint inhibitors (ICIs) have significantly improved outcomes in advanced malignancies but are frequently associated with immune-related adverse events. Vitiligo, a distinctive cutaneous immune-related adverse event, correlates with favorable prognosis in melanoma patients; however, its association with different ICI regimens and occurrence in nonmelanoma cancers remains inadequately characterized. We retrieved ICI-related vitiligo cases from the FDA Adverse Event Reporting System database between January 2015 and September 2025. Disproportionality analysis was performed using reporting odds ratio, proportional reporting ratio, Bayesian confidence propagation neural network, and multi-item gamma Poisson shrinker algorithms. The potential biological mechanisms underlying vitiligo induced by ICIs were examined using The Cancer Genome Atlas data. A total of 591 ICI-induced vitiligo cases were identified, wherein 358 (60.6%) and 177 (29.9%) were reported as anti-programmed cell death protein 1 and combination therapy. Combination therapy exhibited the highest crude incidence rate (0.57%), while anti-programmed death-ligand 1 monotherapy showed the lowest (0.06%). The ipilimumab-pembrolizumab combination demonstrated the highest reporting odds ratio (97.2, 95% CI: 58.1-162.4). Median time-to-onset varied significantly across ICI classes: anti-cytotoxic T-lymphocyte-associated protein 4 monotherapy (33 days), anti-programmed death-ligand 1 (50 days), combination therapy (61 days), and anti-programmed cell death protein 1 (72 days). Patients aged 65 to 79 years showed significantly delayed onset. Geographic analysis revealed prolonged time-to-onset in Asian patients versus Americans. Pan-cancer transcriptomic analysis demonstrated correlations between ICI-induced vitiligo and melanocyte development, innate immunity, and mitochondrial function. ICI-induced vitiligo exhibits significant heterogeneity in risk across treatment strategies, with combination therapy and anti-cytotoxic T-lymphocyte-associated protein 4 strategies conferring higher relative risks. Onset timing is substantially influenced by age and geographic factors. Integration of pharmacovigilance and transcriptomic data implicates coordinated effects of melanocyte-lineage antigens, innate immune and mitochondrial function pathways in vitiligo pathogenesis. This study aimed to systematically characterize the risk profile, onset timing, and potential biological mechanisms of ICI-induced vitiligo across different treatment strategies and cancer types.

Depression has been associated with magnetic resonance imaging (MRI) measures of larger white matter hyperintensity (WMH) volumes and smaller cerebral grey matter volumes (GMV) in predominantly White samples. Recent findings suggest that some race/ethnicity groups may experience more severe health consequences due to depression when it is present compared with experience of depression in White samples. We investigated the association of depressive symptoms with WMH and GMV by race/ethnicity, using a continuous measure of depressive symptoms to more expansively capture participants' experience of depression versus clinical diagnosis alone. A diverse sample of older, northern California Kaiser Healthy Aging and Diverse Life Experiences and Study of Healthy Aging in African Americans participants (n = 550) underwent MRI neuroimaging 2017-2022. Baseline depressive symptoms were measured in 2017 using the NIH PROMIS toolbox. We conducted a literature-informed Bayesian analysis, stratified by race/ethnicity, to examine the association between baseline depressive symptoms and post-baseline WMH and GMV. Our sample was 14% Asian, 54% Black, 16% Latino, and 17% White. Overall, we did not observe an association between depressive symptoms and log(WMH) (0.06, 95% Credible Interval [CrI]: -0.09,0.22) or GMV (-0.74, 95% CrI: -1.62,0.16). In stratified analyses, 1 SD higher depressive symptoms were associated with larger log(WMH) volume (0.21, 95%CrI: 0.002,0.42) among Black participants and smaller GMV among Latino participants (-2.92, 95% CrI: -4.31,-1.52). Unexpectedly, depressive symptoms were associated with larger GMV in Asian participants (2.41, 95% CrI: 0.87,3.95). More severe depressive symptoms were associated with MRI markers of brain aging among Black and Latino participants.

BackgroundAlzheimer's disease and related dementias (ADRD) were the sixth leading cause of death among people aged 65 + in 2022 and are currently the leading cause of disability and morbidity in older adults. In 2025, an estimated 7.2 million Americans aged 65 years and older were living with Alzheimer's disease (AD), with prevalence projected to rise.ObjectiveWe describe 1) the trends in the adoption of ADRD policies that were implemented in the U.S. from 2008-2020, as well as 2) the trends in ADRD mortality during 1999-2022.MethodsWe presented mortality data for the age-adjusted rate of ADRD mortality per 100,000 people in 1999-2022 from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER). We also collected policy data from state websites from 2008-2020.ResultsPolicies were implemented for all 50 states, starting in 2008 and ending in 2020. ADRD mortality steadily rose during 1999-2022. The first states to implement ADRD in 2008 were Iowa and Kentucky. The largest number of states added policies in 2013. South Dakota, Wyoming, Ohio, and Kansas were the last states to implement policies.ConclusionsOur study documented that all the states in the United States implemented a policy to reduce ADRD cases. We also observed that ADRD mortality steadily rose between 1999 and 2022. This rise may reflect increased reporting of ADRD as a cause of death, or policies needing more time to meet national reduction goals.

Advancements in robotic systems have expanded the scope of minimally invasive hepatobiliary surgery. Specifically, the single-port (SP) robotic system offers distinct advantages for single-incision cholecystectomy. This study aimed to evaluate perioperative outcomes between SP robotic cholecystectomy (SP RC) and conventional laparoscopic cholecystectomy (LC). This retrospective, single-center study included patients who underwent LC or SP RC between November 2020 and April 2023. Propensity score matching (PSM) was performed using covariates including age, sex, body mass index, American Society of Anesthesiologists score, GB stone, GB polyp, acute cholecystitis, DM, HTN, the number of cases of preoperative ERCP, and the surgeon. Of the 1184 enrolled patients, 340 pairs were successfully analyzed after PSM. Perioperative outcomes, including operative time, pain scores, length of stay, and postoperative complications, were compared between the matched groups. After PSM, BMI was comparable between the LC and SP RC (24.6 vs. 25.2&#xa0;kg/m2, P&#x2009;=&#x2009;0.824). The operative time was significantly shorter in the SP RC group (45.0 vs. 40.0&#xa0;min, P&#x2009;<&#x2009;0.001). There were no significant differences in postoperative pain scores (3 vs. 3 scores, P&#x2009;=&#x2009;0.247) or incidence of symptomatic incisional hernia (4 vs. 6 cases, P&#x2009;=&#x2009;0.754). SP RC demonstrated comparable safety and feasibility to conventional LC. Further prospective studies are needed to assess its broader clinical applicability.

In children (&#x2264;14 yr) and adolescents (15-19 yr), cancer is highly heterogeneous and essentially differs from adult malignancies. Given the numerous sequelae and fitness impairments associated with treatment, there is a growing number of randomized controlled trials assessing the effects of exercise interventions in affected children/adolescents. As such, the purpose of this American College of Sports Medicine Expert Consensus Statement was to develop the first set of exercise guidelines for children/adolescents with cancer. We identified a list of outcomes with clinical relevance for the target population on which exercise may theoretically induce an improvement and developed exercise recommendations for those outcomes where there is sufficient evidence supporting such effect during/beyond treatment in children/adolescents. Exercise training can generally be performed safely for children/adolescents with cancer. There is moderate evidence that concurrent (aerobic and strength) exercise training can improve two common cancer/treatment-related health outcomes, muscle strength and physical function, but not physical activity levels. Moderate evidence also supports that aerobic exercise improves cardiorespiratory fitness after (but not during) treatment. The evidence is, however, insufficient for other important outcomes (e.g., cardiac function, bone health, and immune function), reflecting a gap in the current state of knowledge. The proposed recommendations should serve as an initial guide for healthcare and fitness professionals working with children/adolescents with cancer. Although current advances in the field are tantalizing, more research is needed to fill remaining gaps in knowledge to better serve this population and to improve clinical practice.

Older adults with type 2 diabetes mellitus (T2DM) often face challenges in achieving glycemic targets due to geriatric conditions. However, evidence on sex differences in failure to achieve glycemic targets in low- and middle-income countries remains limited. To examine sex differences in the prevalence of failure to achieve individualized glycemic targets and to identify associated factors among older adults with T2DM in Vietnam. This cross-sectional study was conducted between September and December 2025 among outpatients aged &#x2265;60 years with T2DM. Failure to achieve glycemic targets was defined based on individualized HbA1c targets according to geriatric conditions, including comorbidities, cognitive function, and functional status, in accordance with recommendations from the American Diabetes Association. Multivariable logistic regression analyses were performed in the overall population and stratified by sex. Among 537 patients, 306 (57.0%) were male and 231 (43.0%) were female. Overall, 25.5% of patients failed to achieve their glycemic targets, with a similar prevalence in males (24.8%) and females (26.4%). In the overall population, polypharmacy (adjusted odds ratio [aOR] 1.98, 95% confidence interval [CI] 1.14-3.44), limitations in instrumental activities of daily living (IADL) (aOR 1.72, 95% CI 1.14-2.61), and diabetes duration &#x2265;5 years (aOR 2.07, 95% CI 1.15-3.75) were independently associated with failure to achieve glycemic targets. In sex-stratified analyses, diabetes duration &#x2265;5 years was associated with failure to achieve glycemic targets among males (aOR 3.30, 95% CI 1.34-8.13), whereas dependent income (aOR 3.60, 95% CI 1.18-10.9), polypharmacy (aOR 2.46, 95% CI 1.02-5.95), and limitations in IADL (aOR 2.39, 95% CI 1.28-4.46) were significantly associated with failure to achieve glycemic targets among females. Failure to achieve glycemic targets remains common among older adults with T2DM in Vietnam, with sex-specific associated factors. These findings suggest that incorporating geriatric assessment and sex-sensitive approaches into outpatient diabetes management may be beneficial; however, they should be interpreted as hypothesis-generating and may not be generalizable to all settings.

In light of US Food and Drug Administration (FDA) warnings about adverse effects of statin therapy, some of which resemble menopausal complaints, this study compared menopause-related manifestations [Menopause Rating Scale (MRS), cognitive, and musculoskeletal symptoms] between users and non-users of statins among postmenopausal women. This multinational, cross-sectional sub-analysis of the REDLINC XII study included 1,184 postmenopausal women from nine Latin American countries. Menopausal symptoms were assessed with the MRS, cognitive function with the Montreal Cognitive Assessment (MoCA), and sarcopenia risk with the SARC-F questionnaire. Multivariable logistic regression models evaluated associations between statin therapy and outcomes (menopausal symptoms, cognition, and sarcopenia risk) after adjustment for sociodemographic, lifestyle, and clinical factors. Of the 1,184 women, 307 (25.9%) used statins. Compared with non-users, statin users had a higher prevalence of severe menopausal symptoms (47.2% vs. 30.6%), more intense musculoskeletal symptoms (53.1% vs. 33.9%), and higher sarcopenia risk (28.7% vs. 16.5%; all P=0.0001). In multivariable logistic regression analyses, statin therapy was not associated with mild cognitive impairment defined by the MoCA global score, although exploratory analyses suggested poorer performance in delayed recall memory and visuospatial function among users. Statin therapy remained independently associated with severe menopausal symptoms [odds ratio (OR): 1.56; 95% CI: 1.17-2.10] and sarcopenia risk (OR: 1.65; 95% CI: 1.19-2.29). In postmenopausal women, statin therapy was not associated with mild cognitive impairment; however, statin use was linked to poorer delayed recall memory and visuospatial function and a higher burden of menopausal symptoms and sarcopenia risk. Statin-related cognitive and somatic effects may overlap with menopausal symptomatology and contribute to symptom burden during midlife.

The current study sought to understand the role of identity in explaining the relationship between perceived discrimination, medical mistrust and maternal healthcare communication satisfaction. Black individuals (N&#x2009;=&#x2009;160) who had recently given birth in a US hospital participated in an online survey based on the Communication Theory of Identity (CTI). A path analysis indicated that, as hypothesized, identity gaps (i.e. discrepancies between one's personal identity and one's communication behaviors or perceived ideas of their roles in relationships and society) explained the relationship between perceived discrimination, medical mistrust, and communication satisfaction. These results are discussed in terms of their implications for the CTI and how clinicians, policymakers, and community organizations can use this theoretical framework to inform decision-making and reduce Black maternal health communication disparities in US healthcare.

Childhood obesity is increasingly prevalent and historically considered a risk factor for surgical complications. Evaluating the influence of body mass index (BMI) on pediatric surgical outcomes is critical for guiding care. This study aimed to examine the relationship between BMI and postoperative outcomes in children. Cohort study of patients aged 2-18&#xa0;years undergoing general surgical, urological, or gynecological procedures at National Surgical Quality Improvement Program-Pediatric hospitals (2012-2023). The exposure was BMI categories defined by American Academy of Pediatrics and Centers for Disease Control and Prevention. The primary outcome was the Desirability of Outcome Ranking (DOOR), a composite measure of 22 postoperative events ranked from 1 (no complication) to 6 (worst complications). Ordinal logistic regression models, adjusted for clinical risk, assessed the association between BMI and DOOR. Among 373,315 patients (mean age 10.8&#x2009;&#xb1;&#x2009;4.7&#xa0;years; 54.2% male), 7.1% were underweight, 55.1% normal weight, 15.1% overweight, 12.3% class I obesity, 6.0% class II obesity, and 4.3% class III obesity. Unadjusted analyses showed fewer complication-free courses (DOOR score 1) in underweight children, while class II-III obesity had the highest proportion of complication-free courses. In adjusted analyses, underweight was associated with worse DOOR scores (OR 1.08, 95% CI 1.04-1.12) while Class II (OR 0.89, 95% CI 0.85-0.94) and class III obesity (OR 0.76, 95% CI 0.71-0.81) were protective. Subgroup analyses showed that in elective general surgery, class II (OR 0.79, 95% CI 0.73-0.86) and class III obesity (OR 0.65, 95% CI 0.59-0.72) remained protective, whereas in non-elective general surgery, underweight status was still predictive of worse DOOR scores (OR 1.25, 95% CI 1.16-1.34). Extremely low BMI was consistently linked to less desirable postoperative outcomes, whereas obesity was paradoxically associated with more favorable DOOR scores. Elevated BMI alone should not be considered a contraindication to pediatric surgery. Efforts to optimize underweight children may offer the greatest opportunity to improve surgical outcomes.

Hepatocellular carcinoma (HCC) with tumor thrombus extending into the inferior vena cava (IVC) represents an advanced stage of disease and is associated with a poor prognosis. Surgical resection combined with thrombectomy remains a potentially curative option but carries substantial perioperative risk. Intraoperative transesophageal echocardiography (TEE) provides real-time imaging that may improve procedural safety and surgical precision. We report the case of a 49-year-old woman with advanced HCC complicated by tumor thrombus extending from the left portal vein and left hepatic vein into the IVC, with intermittent prolapse toward the right atrium. Preoperative assessment showed Child-Pugh class A liver function (score 6), an Eastern Cooperative Oncology Group (ECOG) performance status of 2, chronic hepatitis B infection without prior antiviral therapy, and preserved coagulation function. Imaging demonstrated cirrhosis and splenomegaly. The patient underwent left hemihepatectomy with IVC tumor thrombectomy under continuous intraoperative TEE guidance. TEE enabled dynamic assessment of thrombus mobility, guided repositioning of the thrombus from the right atrium into the IVC, informed the clamping strategy, and allowed immediate detection of acute bland thrombus formation after vascular repair. Prompt re-intervention was undertaken, and IVC patency was successfully restored. Histopathology confirmed moderately to poorly differentiated HCC with vascular invasion and tumor thrombus [pT4N0M0, American Joint Committee on Cancer (AJCC) 8th edition]. Postoperatively, the patient developed intrahepatic recurrence and received transcatheter arterial chemoembolization (TACE) and targeted therapy. At 12-month follow-up, no recurrence of IVC tumor thrombus was detected. This case highlights the value of anesthesiologist-led intraoperative TEE in complex oncovascular surgery. Continuous TEE guidance facilitated key vascular maneuvers, supported real-time intraoperative decision-making, and enabled early recognition of a potentially life-threatening complication. TEE should be considered an important intraoperative navigation tool in high-risk HCC thrombectomy.

BackgroundThe COVID-19 pandemic strained hospital systems and post-pandemic data on colectomy trends for diverticulitis are limited. We aimed to describe trends in colonic resections in patients with diverticulitis before, during, and after the pandemic.MethodsThis retrospective cohort study queried the American College of Surgeons NSQIP database, analyzing patients who underwent a colectomy for diverticulitis during quarters 2-4 (April 1-December 31) in 2018 ("pre-COVID"), 2020 ("during COVID"), and 2022 ("post-COVID"). The primary study outcome was emergency case rates during the 3 time periods. Secondary outcomes included trends in patient comorbidities, severity of presenting illness, 30-day postoperative complications, and disposition status.ResultsA total of 21,642 patients were studied (7163 pre-COVID, 6254 during COVID, and 8225 post-COVID). Emergency cases of diverticulitis increased to 21% during the COVID period but remained at 17% and 18% during the pre-COVID and post-COVID periods, respectively (P < 0.001). Similarly, end colostomy creation rates rose to 20% during COVID and returned to baseline levels (18%) after the pandemic (P < 0.001). Hospital length of stay and 30-day mortality increased during the COVID period and remained slightly elevated post-COVID.ConclusionsThe COVID-19 pandemic was associated with a temporary increase in emergency colectomies and end colostomy creations for diverticulitis, with operative urgency returning to pre-pandemic levels in the post-COVID period. Short-term postoperative outcomes also shifted modestly during and after the pandemic. These findings offer a national perspective on trends in the surgical management of diverticulitis during and after the pandemic and may help guide surgical practice during future health care disruptions.

Microbiome research is a dynamic, rapidly growing, and interdisciplinary field that generates valuable insights across the human health, agricultural, and environmental sectors. Despite this growth, gaps remain in educational content and professional development opportunities specifically tailored for microbiome science rather than traditional microbiology. The National Microbiome Data Collaborative (NMDC) has developed a Microbiome Science Certificate Program aimed at undergraduates but available to any learner or researcher interested in this field. The curriculum includes 12 modules to further technical knowledge, as well as practical and professional skills. The modules each include prepared slide decks, recorded lectures, resource documents, expert interviews, reading assignments, knowledge assessments, and an overall glossary. The modular content can be readily applied within the classroom as a stand-alone semester-long course or as supplementary to existing curricula. An asynchronous, online, certificate-granting implementation of the content is available through the American Society for Microbiology. We have outlined future laboratory, workforce development, and data science "mini-modules" that can be further developed with the help of educators. Improvements will be made to the program content based on feedback from learners and educators. This program aims to promote practical skills to empower the next generation of microbiome researchers.

Bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) is a preferred antiretroviral regimen in international guidelines, but long-term real-world data in Latin American people living with HIV (PLWH) are scarce. This study describes 48-month persistence, virological effectiveness, safety and metabolic changes in the Argentine BICTARG cohort. We conducted an observational, retrospective, open cohort study including treatment-na&#xef;ve (TN) and treatment-experienced (TE) adults with HIV who initiated B/F/TAF between October 2019 and December 2022 at a large HIV centre. Persistence on B/F/TAF, virological suppression (VS, <50 copies/mL), B/F/TAF-related adverse events (AEs), and metabolic parameters (fasting glucose, cholesterol, and triglycerides) were assessed at 24, 36 and 48 months. Overall, 3,057 PLWH were included: 425 TN (14%) and 2,632 TE (86%). In TN, persistence at 24, 36 and 48 months was 99%, 97% and 95%, and VS rates were 95%, 93% and 90%, respectively, with no AEs reported. In TE, persistence was 98%, 96%, and 88%, and VS rates were 96%, 98%, and 98%; AE rates were &#x2264;0.4%, with no virological failure. Fasting glucose remained unchanged; TN participants showed increases in total, LDL, and HDL cholesterol, whereas in TE participants, lipid levels were stable and triglycerides decreased over time (p<0.001). In this large Argentine cohort, B/F/TAF demonstrated high persistence, sustained VS, low AE rates and an overall favourable metabolic profile over 48 months in both TN and TE PLWH, providing the first long-term real-world evidence from Latin America. Bictegravir/emtricitabina/tenofovir alafenamida (B/F/TAF) es un esquema antirretroviral preferido en las gu&#xed;as internacionales, pero existen pocos datos de vida real a largo plazo en personas latinoamericanas con VIH (PVVIH). Este estudio describe la persistencia, efectividad virol&#xf3;gica, seguridad y evoluci&#xf3;n metab&#xf3;lica hasta 48 meses en la cohorte BICTARG en Argentina. Estudio observacional, retrospectivo, de cohorte abierta que incluy&#xf3; adultos con VIH, na&#xef;ve al tratamiento (TN) y experimentados (TE), que iniciaron B/F/TAF en octubre de 2019 y diciembre de 2022 en un centro de referencia. Se evaluaron la persistencia en B/F/TAF, la supresi&#xf3;n virol&#xf3;gica (SV, <50 copias/mL), los eventos adversos (EA) y par&#xe1;metros metab&#xf3;licos (glucemia en ayunas, colesterol y triglic&#xe9;ridos) a 24, 36 y 48 meses. En total, se incluyeron 3.057 PVVIH: 425 TN (14%) y 2.632 TE (86%). En TN, la persistencia a los 24, 36 y 48 meses fue del 99%, 97% y 95%, y las tasas de SV fueron del 95%, 93% y 90%, respectivamente, sin EA reportados. En TE, la persistencia fue 98%, 96% y 88%, y las tasas de SV fueron del 96%, 98% y 98%; las tasas de EA fueron &#x2264;0,4%, sin fracaso virol&#xf3;gico. No se observaron cambios en glucemia; los participantes TN mostraron aumentos en el colesterol total, LDL y HDL, mientras que en los participantes TE los niveles lip&#xed;dicos se mantuvieron estables y los triglic&#xe9;ridos disminuyeron (p<0,001). En esta gran cohorte argentina, B/F/TAF demostr&#xf3; alta persistencia, SV sostenida, bajas tasas de EA y un perfil metab&#xf3;lico globalmente favorable durante 48 meses tanto en PVVIH TN como TE, aportando la primera evidencia de vida real a largo plazo en Latinoam&#xe9;rica.

Adult intestinal malrotation is rare, and data comparing minimally invasive surgery (MIS) to open Ladd's procedures in this population are limited. This study evaluates perioperative outcomes and MIS utilization in adults. A retrospective cohort study using the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) 2022-2023 datasets identified adults undergoing Ladd's procedure. The primary outcome was total hospital length of stay (tLOS); secondary outcomes included postoperative LOS (pLOS), 30-day morbidity, and mortality. Multivariable linear and logistic regression identified independent predictors of LOS and MIS utilization. Of 142 Ladd's procedures identified in adult patients (109 open, 33 MIS), MIS patients were younger (mean age 47.0 vs. 58.2&#xa0;years, p&#x2009;=&#x2009;0.005), more often female (78.8% vs. 53.2%, p&#x2009;=&#x2009;0.014), and more likely undergoing elective surgery (51.6% vs. 24.8%, p&#x2009;=&#x2009;0.005). Total LOS (3.12 vs. 7.89&#xa0;days, p&#x2009;<&#x2009;0.001) and pLOS (2.45 vs. 6.81&#xa0;days, p&#x2009;<&#x2009;0.001) were significantly shorter in the MIS cohort. 30-day morbidity and mortality were similar. Multivariable linear regression showed MIS approach (B&#x2009;=&#x2009;-&#xa0;0.871, 95% CI -&#xa0;1.137, -&#xa0;0.604, p&#x2009;<&#x2009;0.001), higher ASA class (B&#x2009;=&#x2009;0.347, 95% CI 0.068, 0.627, p&#x2009;=&#x2009;0.015), and days from admission to surgery (B&#x2009;=&#x2009;0.180, 95% CI 0.119, 0.240, p&#x2009;<&#x2009;0.001) independently predicted tLOS. These represent a 58.1% reduction in tLOS for MIS approach, 41.5% increase for higher ASA class, and 19.6% increase per day of surgical delay. MIS approach (B&#x2009;=&#x2009;-&#xa0;0.893, p&#x2009;<&#x2009;0.001) and higher ASA class (B&#x2009;=&#x2009;0.395, p&#x2009;=&#x2009;0.012) independently predicted pLOS, representing 59.1% reduction and 48% increase, respectively. Younger age (OR 0.97, p&#x2009;=&#x2009;0.040) and elective surgery (OR 0.33, p&#x2009;=&#x2009;0.024) independently predicted MIS utilization. MIS Ladd's procedures in adults were associated with significantly shorter hospital stays without an associated increase in 30-day morbidity or mortality. For those undergoing elective Ladds procedure for malrotation without volvulus, MIS Ladd's appears to be a viable surgical approach to consider.

The Latin American Society of Pediatric Infectious Diseases (SLIPE) convened a multidisciplinary expert panel to assess the post-pandemic epidemiology of invasive pneumococcal disease (IPD) in Latin America and the Caribbean. The COVID-19 pandemic initially reduced IPD incidence due to non-pharmaceutical interventions, but subsequent relaxation of restrictions, coupled with immunization gaps, led to a resurgence of pneumococcal infections. The consensus statement reviews literature and regional surveillance data to analyze how disrupted vaccination programs, socioeconomic inequities, and weakened healthcare systems amplified the regional vulnerability to vaccine-preventable diseases. This document addresses epidemiologic changes in IPD following the pandemic, the interplay between respiratory viral infections and pneumococcal disease, trends in pneumococcal conjugate vaccine (PCV) coverage and related barriers, and the emergence of non-vaccine serotypes causing IPD. Sustaining herd protection in the region requires strengthening vaccination infrastructure, restoring confidence through effective communication, and ensuring the completion of booster doses in the second year of life. Despite limited serotype data, countries should prioritize the timely adoption of higher-valency PCVs in feasible schedules to mitigate the growing burden of pneumococcal disease and prevent further setbacks in child health.

The objective of this study was to examine the long-term perceptions of the value of receiving an amyloid PET scan, a test used to diagnose Alzheimer's disease, among Medicare beneficiaries with cognitive impairment and their care partners. An exploratory qualitative research design was used. A total of 100 in-depth semi-structured interviews were conducted with a purposeful sample of CARE-IDEAS participants two to three years post-scan. A team of coders applied qualitative content analysis to identify content about the value of the scan, which was then analyzed using thematic analysis, and stratified by diagnostic category (mild cognitive impairment vs. dementia) and scan results (elevated amyloid vs. not elevated). A majority of amyloid PET scan recipients and their care partners emphasized major benefits of receiving the scan including increased certainty about diagnosis, the ability to prepare for the future, potentially accessing treatment or trials, the ability to contribute to research, and limited procedural risks. Some participants also reported concerns about the cost of the scan, the lack of effective treatment options and clear prognostic information, the limited impact on their lives or treatment plans, and the emotional toll of living with the results. Their views and endorsements of the scan were shaped by their health and personal circumstances (e.g.,&#xa0;seen as less relevant among those with rapidly declining health), and by their preference for more information and involvement in decision-making. The perspectives of persons living with cognitive impairment and their care partners about the value of amyloid PET scans differed across disease trajectories and personal circumstances. These experiences should be taken into consideration when advising symptomatic patients on the benefits and drawbacks of biomarkers for Alzheimer's disease.

Repetitive head acceleration events (RHAE) are common in contact sports and associated with neuroinflammation, axonal injury, and long-term neurological impairments, including increased risk for chronic traumatic encephalopathy. Current strategies for addressing RHAE focus on post-injury care rather than proactive neuroprotection, leaving athletes vulnerable to cumulative neurotrauma. Transcranial photobiomodulation (PBM) has shown promise in reducing neuroinflammation and promoting neuroprotection in traumatic brain injury; however, its potential to mitigate the structural brain changes associated with RHAE in actively competing athletes has not been investigated. The aim of this study was to investigate whether PBM mitigates RHAE-related neuroinflammatory and microstructural changes in collegiate American football players over a single National Collegiate Athletic Association Division I season. We hypothesized that restricted diffusion imaging (RDI) and quantitative anisotropy (QA), diffusion magnetic resonance imaging markers of neuroinflammation and axonal remodeling, respectively, would increase in the Sham PBM group due to RHAE exposure but remain stable in the Active PBM group, indicating neurological resilience. Twenty-six collegiate football players were randomly assigned to Active (n = 13) or Sham (n = 13) PBM groups. PBM (810 nm) was self-administered 3 days a week under supervision in the athletic training room with a transcranial plus intranasal device throughout the preseason practice period and regular season (16 weeks). Diffusion MRI data were collected pre- and postseason, and correlational tractography was used to assess the effects of PBM on longitudinal changes in RDI and QA. Moderation analyses examined time &#xd7; group interactions, with post hoc analyses exploring within- and between-group differences in RDI and QA cross-sectionally and longitudinally. Correlational tractography revealed significant main effects and interactions of time and group, with widespread increases in RDI and QA observed in the Sham PBM group over the season, consistent with neuroinflammation and axonal remodeling. In contrast, the Active PBM group showed relative stability in RDI and QA over time, with significant reductions observed in some areas. These findings suggest that PBM may mitigate ongoing neuroinflammation and facilitate the recovery processes. This study provides the first evidence suggesting that transcranial PBM reduces neuroinflammatory and axonal injury markers in American collegiate football players over a single season. PBM may serve as a noninvasive and accessible intervention for mitigating the cumulative neurological effects of RHAE exposure, offering a neuroprotective strategy for athletes participating in collision and contact sports. Future research should examine the long-term benefits of PBM across multiple seasons and its impact on functional outcomes to further establish the role of PBM in athlete brain health and wellness.